Regulation of Fibrinogen Synthesis in Portal Hypertension

The fibrinogen synthesis rate in patients with cirrhosis of the liver is enhanced. To confirm this, both experimental and clinical investigations were carried out. The fibrinogen synthesis rate was studied, using the incorporation rate of 14-C-Leucine into thrombin clottable plasma protein in the setting of experimental portal hypertension caused by gradual occlusion of the portal vein. Under these conditions the plasma distribution space increased to 148% of the control (day 6). This was dependent on the amount of the portocaval shunt volume. While plasma fibrinogen concentration remained unaltered, the plasma fibrinogen pool increased to 154% of the controls. At the same time, the fibrinogen synthesis rate increased to 159%. In relation to liver weight per 100 gm body weight the rate of synthesis was much more enhanced (211 % of control). During the decline to normal plasma volume, due to a decrease of portocaval shunt volume, the fibrinogen synthesis was inhibited (61% of control).

Under clinical conditions in patients with cirrhosis and portal hypertension, the pathophysiological state is in important aspects comparable to the experimental model. A group of 28 patients with cirrhosis was investigated from the same point of view. In these patients the plasma volume and the plasma fibrinogen pool was markedly increased, depending again on the portocaval shunt volume but not on the portal pressure. From these data it is concluded that in patients with cirrhosis fibrinogen synthesis is enhanced.

[Quality standards for ultrasonographic assessment of peripheral vascular malformations and vascular tumors. Report of the french society for vascular medicine. 2018 Update]

The quality standards of the French Society of Vascular Medicine for the ultrasonographic assessment of vascular malformations are based on the two following requirements: (1) technical know-how: mastering the use of ultrasound devices and the method of examination; (2) medical know-how: ability to adapt the methods and scope of the examination to its clinical indication and purpose, and to rationally analyze and interpret its results.

AIMS OF THE QUALITY STANDARDS

To describe an optimal method of examination in relation to the clinical question and hypothesis. To homogenize practice, methods, glossary, and reporting. To provide good practice reference points, and promote a quality process.

ITEMS OF THE QUALITY STANDARDS

The 3 levels of examination; their clinical indications and goals. The reference standard examination (level 2), its variants according to clinical needs. The minimal content of the examination report; the letter to the referring physician (synthesis, conclusion and proposal for further investigation and/or therapeutic management). Commented glossary (anatomy, hemodynamics, semiology). Technical bases. Setting and use of ultrasound devices. Here, we discuss ultrasonography methods of using of ultrasonography for the assessment of peripheral vascular malformations and tumors (limbs, face, trunk).

A New Calculation Model and Optimization Method for Maddock Mixers in Single Screw Plasticising Technology

A homogenous melt is the prerequisite to achieve the demanded product quality in single screw plasticising technology. At higher screw speeds and mass flow rates solid particles can occur in the melt. Dispersive mixing elements are often used to improve the melt quality. Calculation models are necessary for designing mixing elements in the right way. A new model for the often used fluted mixing sections like axial and spiral Maddock-elements and Z-elements is presented in this paper.

The calculation model is reduced to a single pair of inlet and outlet flute, connected by the shearing gap. Especially in spiral Maddock mixers the longitudinal flow in the flutes is a combined pressure and drag flow but in axial Maddock mixers pure pressure flow occurs. In the shearing gap a combined pressure and drag flow can occur. The leakage flow through the flight clearance is also considered.

Geometry functions are introduced for considering the rectangular or circular segment shaped cross section of the flutes. The viscosity is shear rate and temperature dependent, the channel height as well as the channel width can vary along the mixing element. The model allows the calculation of the longitudinal pressure profile in the inlet and outlet flutes, the total pressure drop and the shear stress distribution in the shearing gap.

Mixing sections sometimes show a too high pressure consumption and insufficient shearing efficiency. Therefore a geometry optimization method for axial Maddock mixing heads is presented in this paper.

[Long-term results of the reduction mammaplasty with Revers T-technique]

Functional and aesthetic aspects make the reduction mammaplasty a favoured surgical procedure. The vertical technique, as well as the technique with central pedicle have clearly gained in importance next to the traditional T-cut technique. We provided questionnaires to a random sample of 110 patients who had been treated according to the method of Strömbeck-Weiner. The results were evaluated and compared with the literature. Our results show that the functional complaints were largely eliminated by the surgery and that the patients experienced a significant improvement in their psychological well being. The applied method produces a satisfactory shape of the breast with programmed ptosis, and to large extent retains the nipple-areola sensitivity. One shortcoming of this procedure is the scar formation which 20 % of the patients found bothering. However, 94 % of the patients would choose the procedure again. We conclude that the reduction mammaplasty with reverse T-technique according to Strömbeck-Weiner continues to be of value for patients with a desired weight reduction of more than 500-600 g and patients over the age of fourty.

[Painful bruising syndrome]

A 54-year old anorectic patient with painful bruising syndrome (Gardner-Diamond syndrome) suffered from various gastrointestinal and psychologic complaints. The episodes of painful bruising could be provoked following intradermal injection of washed red blood cells within 96 h. The pathogenesis of this rare entity is more likely due to a psychiatric alteration rather than to the immunological mechanisms, as had been postulated two decades ago. Nevertheless, the Gardner-Diamond-syndrome should be included in the differential diagnosis of ecchymotic bleeding.

The genetic basis for cytopathogenicity of pestiviruses

Two biotypes of pestiviruses, cytopathogenic (cp) and noncp viruses, can be distinguished by their effects on tissue culture cells. Identification of cp bovine viral diarrhea virus (BVDV) has been frequently reported since antigenically closely related noncp and cp BVDV can be isolated from cattle with fatal mucosal disease (MD) and are called a virus pair. In contrast to the BVDV system, only few cp border disease virus (BDV) and cp classical swine fever virus (CSFV) strains have been described. Serological analyses and sequence comparison studies showed that cp pestiviruses arise from noncp viruses by mutation. Elaborate studies during the last 10 years revealed that in most cases RNA recombination is responsible for the generation of the cp viruses. Recent results showed a second way for the development of a cp pestivirus which is based on the introduction of a set of point mutations within the NS2 gene.

Intracavitary contrast intensity after transpulmonary transmission of a second-generation contrast agent at normal and reduced myocardial contractility

In this closed-chest preparation in 10 anesthetized pigs, we determined the effects of left ventricular (LV) contractility changes on the echocardiographic contrast intensity variation of a second-generation contrast agent within the LV cavity. The peak positive rate of change in LV pressure (dP/dt(max)), as an index of the isovolumetric phase, was gradually reduced by administration of halothane and propranolol, and the velocity of circumferential fiber shortening (Vcfs) was referenced as an index for the LV ejection phase. Contrast intensity-time curves of the LV cavity were obtained after transpulmonary transmission of the contrast agent. An off-line densitometric method was performed to determine peak maximum and minimum intensities (I(max), I(min)) and their difference (I(amp)). Compared with baseline values, at reductions in dP/dt(max) of 50% and 75%, the contrast intensity parameters I(max), I(min), and I(amp) were decreased by 23% +/- 6% and 44% +/- 5%, 24% +/- 5% and 44% +/- 3%, and 31% +/- 6% and 45% +/- 3%, respectively (P <.05). Significant correlations were observed between I(amp) and dp/dt(max) (r = 0.82, P <.003, n = 30) and their changes (r = 0.59, P <.03, n = 20), but correlations between contrast indexes and Vcfs were only moderate. The sensitivity of I(amp) to indicate changes in dP/dt(max) and Vcfs was 0.95 and 0.83, respectively. The cyclic variation of LV intracavitary contrast intensity reflects the isovolumetric contraction phase better than the ejection phase. The results suggest that measurements of cyclic intensity changes may contribute to the assessment of myocardial contractility changes. Underlying biophysical mechanisms and load dependency of this phenomenon require further investigation.

Transnasal transesophageal echocardiography: a modified application mode for cardiac examination in ventilated patients

In 42 endotracheally intubated patients, we examined the utility of a miniaturized monoplane probe for transnasal transesophageal echocardiography (TEE). Transnasal TEE was prospectively evaluated in 26 deeply and 16 mildly sedated patients receiving topical anesthesia with lidocaine jelly 2%. The patients with deep sedation were additionally examined with transoral monoplane and multiplane TEE. Transnasal esophageal insertion of the TEE probe was successfully performed in 90% of patients. Endotracheal malpositioning was corrected in two patients. Nasal bleeding required treatment in another patient. Topical anesthesia was adequate in 82% of mildly sedated patients. Left ventricular short- and four-chamber long-axis views of good quality were obtained with transnasal (transoral) monoplane TEE in 76% (81%) and 92% (96%) of patients (differences not significant). Compared with conventional multiplane TEE, transnasal monoplane TEE missed diagnoses in 19% of patients. The relative error (mean +/- SEM) of quantification with transnasal TEE was <9% +/- 2% for ventricular diameters and <7% +/- 2% for cross-sectional area measurements, with a bias of 0.5 +/- 3.8 cm2 and 0.1 +/- 2.4 cm2 (mean +/- 2 SD) for left ventricular end-diastolic and end-systolic short-axis areas. The relative error in measuring intracardiac flow velocities was >40%, but systolic to diastolic peak velocity ratios at the valvular site were determined with an error <4% +/- 3%. Transnasal monoplane TEE can be performed even in mildly sedated patients with an endotracheal tube without further need for analgesia or sedation. The technique is as useful as conventional transoral TEE to image standard tomographic planes for quantification, but it is less suited for comprehensive echocardiographic diagnosing.

IMPLICATIONS

Transnasal insertion of a miniaturized monoplane transesophageal echocardiography (TEE) probe was studied in endotracheally intubated patients. Nasal passage was well tolerated even by patients with only mild sedation. Imaging quality was similar to conventional transoral monoplane TEE with larger transducers, but technical restraints cause a deficit in complete cardiac diagnosing obtained with multiplane TEE.

Continuous cardiac output monitoring during adult liver transplantation: thermal filament technique versus bolus thermodilution

Continuous thermodilution (CT) using a pulmonary artery (PA) catheter with a thermal filament has the potential for intraoperative on-line monitoring of cardiac output. Liver transplantation frequently requires rapid fluid administration and often includes the use of an extracorporeal veno-venous bypass. To assess the agreement between CT and bolus thermodilution (BT) in such a setting, we conducted a prospective intraoperative study in 14 liver transplant patients. Throughout the operation, CT cardiac output was recorded and paired with BT measurements taken every 30 min and whenever indicated for clinical reason. Corresponding data were assigned to acquisition periods when patients were on or off veno-venous bypass (flow rate 2.5 +/- 0.2 L/min) and were discriminated by the various range of intravenous infusion rates (< 150 mL/h, 150-1000 mL/h, 1000-2000 mL/h, and 2000-4000 mL/h) and the magnitude of cardiac output (< or = 7.5 L/min, 7.5-10.0 L/min, > 10.0 L/min). A total of 270 data pairs was obtained and examined by analysis of agreement (mean difference +/- SD), variance, error, and weighted regression. Trend analysis was performed for significant CT and BT cardiac output changes, defined as changes greater than 15%. Agreement of both methods was best at peripheral intravenous fluid infusion rates < or = 1000 mL/h and BT cardiac output > 10 L/min (0.0 +/- 0.6 L/min) and was unaffected by veno-venous bypass. Discrepancy was most evident at intravenous fluid infusion rates > 2000 mL/h and BT cardiac output < or = 7.5 L/min (2.1 +/- 1.7 L/min). Correlation of CT and BT cardiac output was excellent (r = 0.95, P < 0.001) for combined data from all patients. Changes in CT cardiac output > 15% (n = 116) correctly indicated the direction in 93% of BT cardiac output changes and were 74% sensitive and 75% specific for significant BT cardiac output changes. The thermal filament technique enhances the usefulness of PA catheterization during liver transplantation but reflects BT cardiac output with clinically acceptable error only at low peripheral intravenous fluid infusion rates.

IMPLICATIONS

Cardiac output determines organ perfusion. In clinical practice, it is measured by intermittent thermodilution using right heart catheterization. This intraoperative study compared the intermittent method with a technique based on continuous thermodilution. The new technique provides logistical advantages and challenges the accuracy of the intermittent method during liver transplantation.

The validity of the extension-rotation test as a clinical screening procedure before neck manipulation: a secondary analysis

OBJECTIVE

To determine the validity of the neck extension-rotation test as a clinical screening procedure to detect decreased vertebrobasilar blood flow that might be associated with dizziness.

DESIGN

Secondary analysis of a clinical screening test.

METHODS

Twelve subjects with dizziness reproduced by the extension-rotation test and 30 healthy control subjects had Doppler ultrasonography examination of their vertebral arteries with the neck extended and rotated. Vascular impedance to blood flow was measured and the presence of signs and symptoms of vertebrobasilar ischemia was recorded.

RESULTS

Cut-off points for validity estimates were derived through the percentile and Gaussian methods using impedance to blood flow as the standard. The sensitivity of the extension-rotation test for increased impedance to blood flow was 0%, regardless of the selected cut-off point. The specificity rates for the left vertebral artery were 71% and 67% for the percentile and Gaussian methods, respectively. The extension-rotation test was more specific on the right side, with a rate varying from 90% with the percentile method to 86% with the Gaussian technique. The positive predictive value of the test was 0% and its negative predictive value ranged from 63% to 97%.

CONCLUSION

We were unable to demonstrate that the extension-rotation test is a valid clinical screening procedure to detect decreased blood flow in the vertebral artery. The value of this test for screening patients at risk of stroke after cervical manipulation is questionable.

[Propofol-alfentanil reduced cerebrovascular CO2 reactivity in comparison with isoflurane]

The present study compared the effects of propofol/alfentanil versus isoflurane anaesthesia on cerebral vascular reactivity to changes in carbon dioxide (CO2) using transcranial Doppler sonography (TCD). METHODS. Seventeen ASA class I patients undergoing minor elective surgery were studied following IRB approval and informed consent. In group 1 (n = 10), anaesthesia was induced with thiopental 4 mg/kg and alfentanil 15 micrograms/kg. Endotracheal intubation was facilitated by vecuronium 0.1 mg/kg. Anaesthesia was maintained with 1% end-tidal isoflurane and nitrous oxide (N2O) in oxygen O2 (6 l/min; FiO2 0.3). In group 2 (n = 7), anaesthesia was induced with propofol 2 mg/kg, alfentanil 15 micrograms/kg, and vecuronium 0.1 mg/kg for endotracheal intubation and maintained by infusion of propofol, alfentanil, and N2O-O2 (6 l/min; FiO2 0.3) according to the following protocol: propofol: 10, 8, and 6 mg/kg.h for 10 min each followed by 4 mg/kg.h; alfentanil: 55 micrograms/kg.h. Monitoring included measurement of mean arterial blood pressure (MAP, mm Hg), heart rate (HR), body temperature (T), end-tidal CO2 (PetCO2, mm Hg), isoflurane concentrations, and arterial O2 saturation (SaO2, %). Mean blood flow velocity (Vmean, cm/s) was measured in the middle cerebral artery using a bidirectional 2-MHz TCD system (TranspectT, Medasonics). Mechanical ventilation was adjusted to achieve PetCO2 levels of 40-50-40-30 and 40 mm Hg. Ten minutes of equilibration were allowed at each PetCO2 level. The CO2 reactivity index was calculated as delta Vmean/delta PetCO2 (cm/s.mm Hg). RESULTS. MAP, HR, T, and SaO2 were constant over time and were not different between groups. The CO2 reactivity index over the CO2 range of 30-50 mm Hg was higher in isoflurane (2.32 +/- 1.51 delta cm/s.mm Hg) compared to propofol/alfentanil patients (1.15 +/- 0.77 delta cm/s.mm Hg) (mean +/- SD, P < 0.05). CONCLUSIONS. The data show that although CO2 reactivity is maintained during both isoflurane and propofol/alfentanil anaesthesia, the cerebral vascular response to CO2 was lower in propofol/alfentanil compared to isoflurane patients. This is likely due to propofol/alfentanil-induced cerebral vasoconstriction. These data suggest that CO2 reactivity is a function of the pre-existing cerebral vascular tone induced by the anaesthetic.

Effect of various head and neck positions on vertebral artery blood flow

The purpose of this study was to assess blood flow velocity in the vertebral arteries with duplex Doppler ultrasound during various positions of the head and neck. Vertebral artery morphology and blood flow velocity were assessed in a control group and in a group of subjects who displayed clinical signs and symptoms of vertebrobasilar insufficiency. The two groups did not differ in vertebral artery gross morphology as assessed by ultrasound. The arteries were examined for vascular impedance by calculating the ratio of peak systolic velocity to end diastolic velocity (systolic/diastolic ratio). In the context of this study, a lower velocity ratio implied less resistance to vascular flow. These velocity ratios were established during several positions of the head and neck, including a widely used provocational test manoeuvre for vertebrobasilar insufficiency. No meaningful significant differences in mean velocity ratios were found between the two groups. None of the subjects had abnormal spectral flow patterns during the different testing positions.

Lumbar motion trends and correlation with low back pain. Part I. A roentgenological evaluation of coupled lumbar motion in lateral bending

OBJECTIVE

A radiographic study was undertaken to describe the relationship between coupled lumbar motion in lateral bending and the presence of low back pain symptomatology, evaluate trends of coupled motion and determine if these trends were attributable to chance confluence of independent motions.

DESIGN

Survey.

SETTING

Chiropractic college student health center and private chiropractic clinic.

PARTICIPANTS

249 subjects: 114 with low back pain, 29 asymptomatic with no history and 106 asymptomatic with history. Of these, 194 were freshman volunteers and 55 were new private clinic low back pain patients.

INTERVENTIONS

None.

MAIN OUTCOME MEASURES

Lumbar segmental coupled motion categories according to the scheme of Cassidy and Grice, as well as a modified scheme.

RESULTS

Statistical analysis demonstrated no significant relationship (p = .01) between coupled lumbar motion and low back pain. When viewed intersegmentally, approximately half of all lumbar motion was type II; symmetric motion was rare and attributable to chance confluence of individual segmental motion.

CONCLUSIONS

This study suggests that back pain is not an indication for the routine use of lateral bending films for the identification of abnormal coupled motion. Furthermore, each segmental categorization appears to be independent of contralateral categorization as well as motion at all other segmental levels. It is also suggested that type II motion cannot be ruled out as a normal variant. Finally, the ubiquity of coupled motion asymmetry suggests that symmetry must be reevaluated as a criterion for normal spinal function.

Left atrial ball thrombus in combined mitral-aortic valve disease

This report describes a patient with left atrial ball thrombus which was detected during echocardiographic evaluation of combined mitral-aortic valve disease. Surgical correction was performed entirely on the basis of the echocardiographic diagnosis.

Interrater reliability of roentgenological evaluation of the lumbar spine in lateral bending

Interrater reliability is described for the evaluation of lumbar motion and motion coupling patterns in lateral bending. Upright neutral and lateral bending lumbar films of 58 student volunteers were marked by three examiners. Segmental tilt, segmental rotation and motion categories were computed. The performance of the examiners was evaluated using the Kappa statistic and a comparison of rater discrepancy to the experimental measurement error. Although all three raters were proficient within the context of calculated measurement error, good reliability was not universally demonstrated. Concordance for rotation was moderate to good, while agreement for lateral bending was of questionable interpretation. Reliability for the segmental motion categories was good for L1-L4, but unacceptable at L5. The poor reliability at L5 resulted in unacceptable concordance for the lumbar global motion category for three raters. The use of lateral bending radiographs for categorization of the lumbar spine in clinical practice is questioned.

[Extracorporeal lithotripsy of gallbladder calculi with piezoelectrically generated shock waves: initial experiences]

A piezoelectric lithotripter ("Piezolith 2300") was used in 24 patients for extracorporeal fragmentation of radiolucent gallbladder stones. In 19 patients with one stone and 4 patients with two stones (diameter: 0.8-3.1 cm) fragmentation to a maximal fragment size of 7 mm was achieved. One to three treatment sessions were necessary (mean 1.5). During adjuvant oral litholytic therapy with chenodeoxycholic acid and ursodeoxycholic acid (500 mg each daily up to 80 kg bodyweight and 750 mg in patients with more than 80 kg bodyweight) 4 patients came to be completely free of stones within a mean follow-up time of 15 weeks. Treatment was well tolerated by all patients, no analgesia or sedation was needed. Side effects were cutaneous petechiae in two patients, microscopic haematuria in two others and leucocyturia in another. We conclude that lithotripsy of gallbladder stones can be performed safely and effectively not only by the established underwater spark discharge type of lithotripter but also by the piezoelectric system.

[Problems of occupationally induced respiratory allergies as exemplified by bakers' asthma]

In the Federal Republic of Germany (FRG) approximately every fourth case of occupational lung disease, registered with application for compensation at the "Gewerbliche Berufsgenossenschaften", in 1984 was suspected to be caused by allergic airway obstruction. Respiratory allergies may arise if two prerequisites exist firstly exposure to sensitizing agents in the work environment and secondly individual disposition to allergic reactions. The large range of sensitizing agents includes organic and inorganic substances derived from animals, plants, fungi, metals or chemicals. Most of them are responsible for Type-I IgE-mediated allergic reactions. Three different patterns of respiratory responses can be found following simulated occupational exposure: immediate, late (non-immediate), and the dual-type of asthmatic reaction, whereby the non-immediate asthmatic response must be strictly differentiated from the genuine Type-III hypersensitivity. Today, bakers' asthma is the most frequent and most costly occupational allergy in the FRG, contributing more than 50% of all registered and more than 75% of all compensated cases. Therefore, flour allergies can be used as a classic model of an occupational allergic disease in order to discuss epidemiological, social and clinical problems, such as prevalence, socioeconomic impact, as well as prevention, early diagnosis and therapeutic measures. Despite many well-known clinical and epidemiological data, respiratory allergies display a lot of unresolved questions calling for further research.

Detection of proteins in wheat flour extracts that bind human IgG, IgE, and mouse monoclonal antibodies

Wheat flour was extracted with phosphate-buffered saline. The biologic significance of the extracted cereal proteins was demonstrated. Basophil leukocytes were obtained from patients suffering from "baker's asthma disease." Histamine release in vitro was induced by addition of the aqueous flour extract. By means of ELISA, as well as immunoblotting technique, IgG and IgE binding to wheat flour proteins was demonstrated. Wheat-specific antibodies could be detected in sera obtained from healthy and atopic individuals. Further analysis of the cereal components by monoclonal antibodies revealed that several wheat molecules exhibit identical epitopes.

Alterations of serum carboxypeptidases N and angiotensin-I-converting enzyme in malignant diseases

The activities of serum carboxypeptidases N (E.C. 3.4.17.3) and serum angiotensin-I-converting enzyme (E.C. 3.4.15.1) were spectrophotometrically measured in patients with hematological disorders and in histologically proven bronchogenic carcinomas. The enzyme activities have been compared with various laboratory parameters. Controls were healthy subjects. No significant sex differences of carboxypeptidases N and angiotensin-I-converting enzyme were found in the healthy controls or in the whole patients' group. The carboxypeptidases N were significantly elevated in patients with lung cancer (p less than 0.0001) compared to the healthy controls. The angiotensin-I-converting enzyme was significantly reduced (p less than 0.0001) in serum of patients with bronchogenic carcinoma. In responders to chemo- and/or radiotherapy, the carboxypeptidases decreased and the angiotensin-I-converting enzyme increased to normal enzyme values. In non-responders to these therapies no change in these enzymes could be observed.

[Automatic contour search and segmentation of sonographic transverse sectional pictures of the uterus with regard to optimization of individual isodose planning in uterine cancer]

Intrauterine ultrasonography has proved to be an adequate method to represent the normal myometrium as well as its pathologic modifications, especially for the assessment of localization and extent of malignant processes. So for the first time, intracavitary radiotherapy of the carcinoma of the body, especially the afterloading technique, can work by means of the produced crossections with a precisely defined target volume, because the sonographic probe and the afterloading probe have identical geometric configurations. A method is presented which allows a computer-assisted determination of the tumor volume by means of the segmentation of organ sections and a pseudo-threedimensional projection in combination with the energy dose distribution of the radioactive source.

[Protease inhibitors, serum endotoxin and serum immunoglobulins following portacaval end-to-side anastomosis in animal experiments]

In order to clarify the pathophysiological mechanism of certain biochemical and immunological changes (endotoxin in serum, protease inhibitors, immunoglobulins) found in a former study on human cirrhosis of the liver the porto-caval end-to-side anastomosis of rats with unaffected livers was chosen as test model. With the aid of this bypass the "spill-over" phenomenon of the liver can be completely imitated. In this study, 7 operated and 5 or 14 control animals resp. are referred to. Serum endotoxin, acid-stable and acid-unstable protease inhibitors and immunoglobulins IgG, IgA and IgM were determined 20 months after operation. For the determination of potential hemodynamically or toxically induced effects on these organs, morphologic liver and lung examinations were performed. On the average, the operated rats showed a weight loss of 8 percent, i.e. from 378.4 +/- 9.2 g to 348.4 +/- 17 g. Compared to control rats, their relative liver weights were significantly lower (34%) (mean = 2.23 +/- 0.2 compared to 3.4 +/- 0.44 g, p less than 0.0005). Serum immunoglobulins IgG, IgA and IgM in operated animals were significantly higher (p less than 0.005 or p less than 0.025 resp. and 0.0025). Endotoxin in serum could be identified in 4 out of 7 operated animals (57, 1%), but in none of the control animals. While there was no difference in serum levels of acid-unstable protease inhibitors between the two groups levels of acid-stable protease inhibitors were in operated animals by 24% higher than in control animals (mean = 35.3 +/- 3.3 compared to 28.5 +/- 2.3 mU/ml, p less than 0.0005).(ABSTRACT TRUNCATED AT 250 WORDS)

Defective desaturation and elongation of n-6 and n-3 fatty acids in hypertensive patients

Hypertensive patients had higher levels of linoleic acid (LA) in serum lipids than normal controls. Administration of large doses of LA failed to raise the percentage of its metabolite arachidonic acid (AA) in serum lipids. Similarly, intake of large amounts of alpha-linolenic acid (alpha-LNA) failed to increase the amount of eicosapentaenoic acid (EPA). The percentage of EPA in serum lipids could readily be increased by direct administration of comparably low doses in a mackerel diet. Hypertensive subjects seem to desaturate and elongate LA and alpha-LNA only very slowly.

[Hematologic and dermatologic side-effects of antibiotic therapy]

The report details possible haematological and dermatological side effects due to co-trimoxazole: agranulocytosis and epidermiolysis bullosa (Lyell) respectively developed after short-term therapy with co-trimoxazole in two women treated for tonsillitis and acute relapse of chronic obstructive bronchitis respectively. The clinical findings, therapeutical management and clinical outcome of both patients are described. Reviewing the literature the relevance of co-trimoxazole induced side effects is discussed.

Allergen-specific histamine release from whole blood in flour-sensitive bakers

We have studied the allergen-specific in vitro histamine release (HR) in 38 flour-sensitive bakers and in 10 controls without occupational exposure after whole blood incubation with native wheat and rye flour and compared the results with the findings in RAST, skin and bronchial provocation tests. The mean in vitro HR from whole blood after incubation with rye flour amounted to 38.1% (range 0-100%) in flour-sensitive bakers and to 8.2% in the controls (p less than 0.005). Concerning the quantity of HR, no significant differences were found when bakers with meal rhinitis or those with flour-induced asthma were compared. Qualitative analysis, however, showed a close correlation between the frequency of positive HR and the severity of the allergic disorder (rhinitis versus asthma). Comparison of in vitro HR with the findings in RAST and skin tests gave a strong correlation of concordant results with the severity of the underlying disease. The highest coincidence of tests was found in patients with flour-induced asthma. The sensitivity of HR was very high when compared with RAST, skin and provocation tests. Although the assay of HR from whole blood may be a very specific indicator of cell sensitivity in the field of allergy research, the present findings indicate that the conventional methods for diagnosing flour allergy in bakers such as inhalative provocation tests cannot be replaced by this in vitro technique.

[Liver changes in acute rheumatic fever]

Following the course of disease in a 19 year old patient with acute rheumatic fever we report the reaction of the liver parenchyma: on histological examination besides a marked steatosis several "unspecific" granulomas were seen. Nutritional and toxic factors were excluded aetiologically. Difficulties in diagnosis and differential diagnosis of acute mono/poly-arthritis as a leading symptom are discussed.